The overall aim of this project is to design and pilot test a surveillance system for low prevalence and high impact congenital and inherited conditions using spina bifida (SB), muscular dystrophy (MD), and fragile X syndrome (FXS) as three representative conditions. We plan to identify existing surveillance systems and sources of data and then implement both a passive and active system in South Carolina and Colorado in Year 1, and add Kansas in Year 2 for this two-year project. We will identify existing local, regional, and national data sources and surveillance systems for the three target conditions, through a review of the literature and through our collaboration with state departments of health, particularly the Birth Defects Monitoring/surveillance programs. After a thorough inventory of programs is identified we will identify gaps and deficiencies in these existing data sources and surveillance systems. After we have learned from existing systems we will develop and execute a plan to integrate all major data sources into a functional surveillance system for the three target conditions simultaneously. The system will include a core module (common elements) and extension modules (condition specific elements). The plan will include a three state approach and it will include an approach to de-duplicate data from multiple sources. We will pilot test the surveillance system and develop a report with recommendations regarding the feasibility of a national surveillance system. The findings will describe the data sources used, barriers encountered in integrating the data sources, and a summary of pilot data including identification of important gaps in information or systems.